Health Care

The U.S. Surgeon General has reported that rates of co-occurring mental illness and substance abuse, especially alcohol, are higher among Native Americans, and that the suicide rate among the Native population is 50 percent higher than the national rate.

The statistics sound like they come from another county. A one in five chance of committing suicide, a one in ten chance of being abused, twice as likely to be placed in foster care, and a one in three chance of living in poverty.

Like many Native people I began my career working for my Tribe soon after graduating with my undergraduate social work degree. The Indian Child Welfare Act was enacted in 1978 because of the high removal rate of Indian children from their traditional homes and essentially from Indian culture as a whole. Before enactment, as many as 25 to 35 percent of all Indian children were being removed from their Indian homes and placed in non-Indian homes, with presumably the absence of Indian culture. In some cases, the Bureau of Indian Affairs (BIA) paid the states to remove Indian children and to place them with non-Indian families and religious groups.

Testimony in the House Committee for Interior and Insular Affairs showed that in some cases, the per capita rate of Indian children in foster care was nearly 16 times higher than the rate for non-Indians. If Indian children had continued to be removed from Indian homes at this rate, tribal survival would be threatened. Congress recognized this, and stated that the interests of tribal stability were as important as that of the best interests of the child. One of the factors in this judgment was that, because of the differences in culture, what was in the best interest of a non-Indian child were not necessarily what was in the best interest of an Indian child, especially due to extended families and tribal relationships.

In October of 1987 I was hired in the first Indian Child Welfare Position in our Tribe’s urban office in Duluth. I loved this time in my career and loved working with our Native families. I learned so much from them about resiliency and survival. I honed my skills and my ability to walk in two worlds. It was an exciting time in Indian Child Welfare in the 1980s. We were pioneers in implementing the Indian Child Welfare Act of 1978. I quickly learned that once Native children were removed they were placed in non Native foster homes which were often far away from their biological family and there were no services being offered to the family to aid in returning the children to their families. The advocacy I provided had a great impact on the high removal rates of Native children from their families. In addition, I was able to work closely with families to help them comply with court mandates for reunification or to identify relatives to care for their children so that the foster care system could be avoided altogether. One glaring gap in services in the foster care system was the lack of Native foster homes. When the opportunity to do something about this arose I accepted the challenge and left my position with the Tribe.

In July of 1993 I was hired by a private, non-profit foster care agency to recruit and license Native foster homes. This was a large agency with offices in all of Minnesota and eventually all of Wisconsin and North Dakota. As a Native person going to work for a dominant culture agency there are inherent risks involved. I was initially viewed as a representative icon rather than as an individual. There is always a fine line between being treated as a token minority and implementing cultural competence standards in an organization. A culturally competent program demonstrates empathy and understanding of cultural differences in treatment design, implementation, and evaluation (Center for Substance Abuse Prevention, 1994). Nowadays cultural competence is increasingly a requirement for funding and accreditation. For many years I was the only minority in the entire organization. I began licensing Native foster homes and before long I had several foster homes and for the first time our community had safe, same race homes for Native children in need of care. During the 18 years I was with this agency over a thousand Native children were cared for in the homes that I licensed. I worked my way up in the organization from case manager to lead social worker to area director to regional director in charge of the northern one third of Minnesota. I had great success in developing a long-term, ongoing cultural competence process within the geographic area that I served. I had a great staff of social workers that, although non Native, had an understanding of the cultural nuances of the Native people that we worked with. Over the 18 years that I worked for the agency I was recruited by competing agencies to work for them. Competing agencies also attempted to start their own Native foster care program in my community without success.

Through my volunteer work and as a member of the board of directors for various agencies a needs assessment showed a gap in services for chemical dependency and mental health services for Native people. The agency I worked for was not willing to diversify to provide services to meet the unmet needs in our community. In hindsight this left me vulnerable to offers from these competing agencies that lurked around the community like vultures. In April of 2011 I was approached by the CEO of a competing agency and I met with him in my office. He offered me a chance to work for his agency and to provide any services that I wanted in the Duluth community. In fact, this agency already had successful chemical dependency and mental health programs in addition to foster care services. I agreed to discuss his proposal with my staff but I asked that he also hire my entire staff as we were a team. He agreed to these terms and within 48 hours my staff and I resigned from our current agency and went to work for one of our competitors.

One by one the Native foster families that I had worked with for many years followed me and my staff to the new agency. Cultural competence starts with the program’s administration although competence requires that people of all levels in an agency learn to value diversity. It was obvious from the beginning that this agency had no desire to achieve cultural competence. In June 2012 it was announced that I was the new Cultural Director for the agency. I was not asked if I wanted to be the Cultural Director. I knew right then that this was the beginning of the end for me.

Being the only Native person in an agency that has 150 employees and then be asked to be in charge of cultural competency for a rigid hierarchical organization is a set up for failure. At the same time my responsibility for the budgeting, marketing and personnel was taken from me and I was reduced to a token status in the agency. For the next ten months I was the cultural director for an agency that was seemingly bent on cultural destructiveness. I was determined to give it everything I had. I did a cultural competency assessment of the agency and came to the conclusion that there was resistance throughout the entire agency. On May 7, 2013 I was notified that my position had been eliminated and I was escorted from the building. The staff and the foster parents were told my termination was because of budget and poor marketing of the office. They seemed to ignore the fact that I wasn’t in charge of the budget or the marketing of the agency.

I’m not here to call for Eric Shinseki’s scalp on a lance. There have been substantial improvements on his watch and his heart is with veterans. Nothing would be improved by imposing a new blood learning curve on the VA right now.

More than a decade ago the clinicians at our American Indian non-profit organization wrote a series of articles related to addiction, Type 2 Diabetes and intergenerational stress with the beginning titles “Killing Us Slowly.” These articles still exist on a number of websites as well as our T.K.

Cannabis legalization is a hot topic. After decades of collective societal distain for the plant ala Reefer Madness, public opinion now seems to be swaying in favor of its use, especially where its medicinal properties are concerned.

On March 25, the US Supreme Court heard arguments in a case brought by a for-profit corporation, Hobby Lobby, claiming it (the corporation) would be denied religious freedom if forced to offer Obamacare compliant health insurance policies that cover birth control to some 13,000 employees.

Let’s talk about liberals and conservatives, in spite of the fact that Indian issues do not split that way. Environmental and economic issues do split that way, and Indians have not yet figured out how to segregate air and water and wildlife.

The federal government’s callous treatment of Jeremy Meawasige, an Aboriginal teenager from the Pictou Landing reserve is nothing less than shameful. This youth is living with cerebral palsy, autism, spinal curvature, and a debilitating accumulation of spinal fluid in the brain.

The rising teenage suicide rate (or attempted suicides) among any population is sorrowful. Multiple youth suicides send waves of hopelessness and despair throughout all communities in which they occur.

We see evidence of sugar’s devastating health effects every day. Take a close look. Over there it’s rotting a child’s teeth, over there it’s taking a diabetic’s foot, and, hey, over there it’s costing the clinic thousands of dollars to treat preventable conditions. What can we do about it?

With open enrollment now started, Oklahomans can enroll in the Affordable Care Act’s (ACA) Marketplace to shop for an insurance plan that fits their health needs and budget, as required by the mandate that goes into effect in 2014.